Traumatic Proptosis

Traumatic proptosis may follow blunt trauma (eg, being hit by a car, fight with another animal). During trauma, the globe is luxated from the orbit, and eyelid spasms prevent its retraction. Secondary orbital hemorrhage and swelling displace the globe further from the orbit. Corneoconjunctival drying and malacia follow. Prognosis depends on pupil size and reflexes, duration of exposure, other globe or orbital damage, breed (brachycephalics are predisposed), and other systemic trauma. Approximately 40%–60% of dogs, but very few cats, recover vision. Treatment begins by providing moisture to lubricate the exposed corneoconjunctiva. General anesthesia followed by a lateral canthotomy and complete temporary tarsorrhaphy with usually two or three interrupted horizontal mattress sutures (placed at one-half thickness of the eyelids) and stents should be followed by systemic antibiotics and corticosteroids as well as topical antibiotics and mydriatics (if miosis is present). Sutures and stents are removed only when a brisk blink reflex returns (usually 7–21 days), or more conservatively, a single suture every 2–3 days until all have been removed. Premature suture removal results in lagophthalmia and persistent and often progressive corneal ulceration. Complications include corneal ulceration, enophthalmia, optic nerve degeneration, keratoconjunctivitis sicca, and medial rectus muscle injury.